Partographs have existed since the 1970s, and they are routinely used in most other countries, but have not taken hold in the United States. Neal describes this proposed partograph as more physiologically based than existing partographs, which continue to describe labor as a linear process.
“Because we don’t use partographs in the United States, it will take some work to get this up and running in the U.S., but that is our goal,” Neal said. “We want to positively impact birth outcomes for moms and babies as well as long-term health for women in the U.S. If our partograph were to spread to other countries, that would be fantastic, too.”
The partograph is not intended for use until a woman is in active labor – which also can be difficult to define. In general, active labor begins when uterine contractions cause the cervix to be dilated to between 3 and 5 centimeters. Women admitted to hospitals before active labor has begun are almost twice as likely to receive oxytocin than are women admitted in active labor.
The tool consists of a chart featuring time passed on the x axis and cervical dilatation and the baby’s descent on dual y axes. The most distinctive feature of this new partograph, however, is that it takes into account the hyperbolic curve that typifies most labors. Previous partographs have predicted that labor progress will be plotted in a straight line.
The proposed partograph features a dystocia line, indicating that when labor plot points appear to the right of that line, a dystocia diagnosis and associated interventions are appropriate.
“Our ‘dystocia line’ is not meant to indicate increased risk of adverse birth outcomes for women who cross to the right of it. Instead, it is designed to improve the safety of those who do not cross this line by decreasing unnecessary oxytocin use and cesarean sections,” Neal said. “Cesarean sections are clearly indicated for some women, but if we’re doing a high volume of unnecessary cesareans on first-time moms, then we are simultaneously affecting the future obstetrical course for those women since a primary cesarean is most commonly followed by repeat cesareans in subsequent pregnancies. Long-term health risks go up with each subsequent cesarean.”
In addition to their pilot study, Neal and Lowe recommend that a large, multicenter clinical trial is needed to test whether their predictions about the partograph’s effectiveness are supported by actual childbirth outcomes.
This work was supported by a grant from the National Institute of Nursing Research.
Source: Ohio State University